Authors:Haugaa K; Potpara T, Boveda S, et al.Abstract: The purpose of this patient survey was to analyse the knowledge, experiences, and attitudes regarding cardiac implantable electronic devices (CIED) in patients with pacemakers, implantable cardioverter-defibrillators (ICDs), or cardiac resynchronization devices. Of the 1644 patients with CIEDs from seven European countries, 88% were over 50 years of age. Most patients (90%) knew what device they were implanted with and felt sufficiently informed about the indications for therapy. As many as 42% of patients needed additional information on the battery replacement and limitations in physical activity. The self-reported incidence of complications was 9%, and among these, a quarter of the respondents felt insufficiently informed about the possibility of complications and their management. The majority of patients (83%) were followed by face-to-face visits, which was the most commonly preferred follow-up strategy by the patients. Nearly 75% of the patients reported improved quality of life after device implantation, but about 40% had worries about their device. Less than 20% had discussed with their physician or thought about device handling in the end-of-life circumstances or end-stage disease. Notably, almost 20% of the ICD patients did not wish to answer the question regarding what they wanted to be done with their ICD in case of end-stage disease, indicating the challenges in approaching these issues.PubDate: Thu, 28 Dec 2017 00:00:00 GMT

Authors:Kotecha D; Chua W, Fabritz L, et al.Abstract: We are in the midst of a digital revolution in health care, although the application of new and useful technology in routine clinical practice is variable. The Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly (CATCH ME) Consortium, in collaboration with the European Society of Cardiology (ESC), has funded the creation of two applications (apps) in atrial fibrillation (AF) for use in smartphones and tablets. The patient app aims to enhance patient education, improve communication between patients and health care professionals, and encourage active patient involvement in the management of their condition. The health care professional app is designed as an interactive management tool incorporating the new ESC Practice Guidelines on AF and supported by the European Heart Rhythm Association (EHRA), with the aim of improving best practice approaches for the care of patients with AF. Both stand-alone apps are now freely available for Android and iOS devices though the Google Play, Amazon, and Apple stores. In this article, we outline the rationale for the design and implementation of these apps. Our objective is to demonstrate the value of integrating novel digital technology into clinical practice, with the potential for patient engagement, optimization of pharmacological and interventional therapy in AF, and ultimately to improve patient outcomes.PubDate: Tue, 10 Oct 2017 00:00:00 GMT

Authors:Roca-Luque I; Rivas Gándara N, Dos Subirà L, et al.Abstract: BackgroundIntra-atrial re-entrant tachycardia (IART) is a frequent and severe complication in patients with congenital heart disease (CHD). Cavotricuspid isthmus (CTI)-related IART is the most frequent mechanism. However, due to fibrosis and surgical scars, non-CTI-related IART is also frequent.ObjectiveThe main objective of this study was to describe the types of IART and circuit locations and to define a cut-off value for unhealthy tissue in the atria.Methods and resultsThis observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55 ± 14.9 years, 40.4% with highly complex cardiac disease). During the study, 114 IARTs were ablated (1.21 ± 0.41 IARTs per patient). Cavotricuspid isthmus-related IART was the only arrhythmia in 51% (n = 48) of patients, non-CTI-related IART was the only mechanism in 27.7% (n = 26), and 21.3% of patients (n = 20) presented both types of IART. In cases of non-CTI-related IART, the most frequent location of IART isthmus was the lateral or posterolateral wall of the venous atria, and a voltage cut-off value for unhealthy tissue in the atria of 0.5 mV identified 95.4% of IART isthmus locations.ConclusionIn our population with a high proportion of complex CHD, CTI-related IART was the most frequent mechanism, although non-CTI-related IART was present in 49% of patients (alone or with concomitant CTI-related IART). A cut-off voltage of 0.5 mV could identify 95.4% of the substrates in non-CTI-related IART.PubDate: Wed, 09 Aug 2017 00:00:00 GMT

Authors:Stankovic I; Voigt J.Abstract: Maass et al.1 introduced the CAVIAR response score as a tool for improving patient selection for cardiac resynchronization therapy (CRT). It is interesting to read, that apical rocking, a simple mechanical dyssynchrony marker, was an independent predictor of volumetric response to CRT and was proposed as one of the four scoring parameters. We would like to congratulate the authors to this study which confirms to a great extend our 1000-patient, multi-centre experience reported in the PREDICT-CRT study which investigated the relationship of apical rocking and septal flash to clinical outcomes following CRT.2 Both apical rocking and septal flash were associated with volumetric response and survival and also had a significant incremental value over clinical variables for the prediction of CRT response.2 Of note, almost identical association of apical rocking and response to CRT was simultaneously reported by other, smaller studies3 and it will hopefully be confirmed by the ongoing EuroCRT study.4 The study by Maas et al. is important as it reflects a reviving enthusiasm for refining guideline-proposed criteria for CRT patient selection and adds to the existing evidence that simple, but robust parameters of left ventricular mechanical dyssynchrony may still work.PubDate: Mon, 26 Jun 2017 00:00:00 GMT

Authors:Tzikas A; Holmes D, Jr, Lakkireddy D, et al.Abstract: The Munich consensus document is a physician-initiated effort to establish better and more consistent methodology for studies related to percutaneous left atrial appendage occlusion (LAAO).1 The document is endorsed by EHRA, EAPCI, and other professional societies. The proposed definitions and endpoints for data collection are based on the available published data, and pertinent clinical experience. Our group aimed to provide meaningful definitions and to recommend data collection strategies that are both clinically relevant and feasible. We would like to thank the authors for their letter.2 Herein, we try to reply to all their comments and questions.PubDate: Wed, 07 Jun 2017 00:00:00 GMT

Authors:Maass A; Vernooy K, Cramer M, et al.Abstract: We thank Stankovic and Voigt1 for their interest in our study2 and agree that the identification of apical rocking as an independent predictor of response to cardiac resynchronization therapy (CRT) in the MARC study is not a new finding.3PubDate: Mon, 05 Jun 2017 00:00:00 GMT

Authors:Verdecchia P; Reboldi G, Angeli F, et al.Abstract: AimWe tested the hypothesis that left ventricular hypertrophy (LVH) interferes with the antithrombotic effects of dabigatran and warfarin in patients with atrial fibrillation (AF).Methods and resultsThis is a post-hoc analysis of the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) Study. We defined LVH by electrocardiography (ECG) and included patients with AF on the ECG tracing at entry. Hazard ratios (HR) for each dabigatran dose vs. warfarin were calculated in relation to LVH. LVH was present in 2353 (22.7%) out of 10 372 patients. In patients without LVH, the rates of primary outcome were 1.59%/year with warfarin, 1.60% with dabigatran 110 mg (HR vs. warfarin 1.01, 95% confidence interval (CI) 0.75–1.36) and 1.08% with dabigatran 150 mg (HR vs. warfarin 0.68, 95% CI 0.49–0.95). In patients with LVH, the rates of primary outcome were 3.21%/year with warfarin, 1.69% with dabigatran 110 mg (HR vs. warfarin 0.52, 95% CI 0.32–0.84) and 1.55% with 150 mg (HR vs. warfarin 0.48, 95% CI 0.29–0.78). The interaction between LVH status and dabigatran 110 mg vs. warfarin was significant for the primary outcome (P = 0.021) and stroke (P = 0.016). LVH was associated with a higher event rate with warfarin, not with dabigatran. In the warfarin group, the time in therapeutic range was significantly lower in the presence than in the absence of LVH.ConclusionsLVH was associated with a lower antithrombotic efficacy of warfarin, but not of dabigatran, in patients with AF. Consequently, the relative benefit of the lower dose of dabigatran compared to warfarin was enhanced in patients with LVH. The higher dose of dabigatran was superior to warfarin regardless of LVH status.Clinical trial registration http:www.clinicaltrials.gov. Unique identifier: NCT00262600.PubDate: Wed, 17 May 2017 00:00:00 GMT

Authors:Poli S; Toniolo M, Maiani M, et al.Abstract: Pharmacologic challenge with sodium channel blockers is part of the diagnostic workout in patients with suspected Brugada syndrome. The test is overall considered safe but both ajmaline and flecainide detain well known pro-arrhythmic properties. Moreover, the treatment of patients with life-threatening arrhythmias during these diagnostic procedures is not well defined. Current consensus guidelines suggest to adopt cautious protocols interrupting the sodium channel blockers as soon as any ECG alteration appears. Nevertheless, the risk of life-threatening arrhythmias persists, even adopting a safe and cautious protocol and in absence of major arrhythmic risk factors. The authors revise the main published case studies of sodium channel blockers challenge in adults and in children, and summarize three cases of untreatable ventricular arrhythmias discussing their management. In particular, the role of advanced cardiopulmonary resuscitation with extra-corporeal membrane oxygenation is stressed as it can reveal to be the only reliable lifesaving facility in prolonged cardiac arrest.PubDate: Wed, 17 May 2017 00:00:00 GMT

Authors:Stöllberger C; Schneider B.Abstract: With great interest, we read the Munich consensus document on definitions, endpoints, and data collection for clinical studies about percutaneous left atrial appendage occlusion (LAAO).1 The authors have to be congratulated for their effort to standardize the definitions and to propose a consistent approach in the reporting of LAAO studies. However, regarding the sequelae of LAAO the following questions and concerns arise.PubDate: Tue, 02 May 2017 00:00:00 GMT

Authors:Mithani A; Kath H, Hunter K, et al.Abstract: AimsIn 2012, the first totally Subcutaneous Implantable Cardioverter-Defibrillator (S-ICD) was approved by the Food and Drug Administration (FDA) in the United States. A possible benefit of this device is that it does not involve placing leads ‘in’ or ‘on’ the heart, potentially reducing complications.Methods amd resultsNinety-one S-ICD and 182 single chamber TV-ICD implants were performed between 10/22/2012 and 9/22/2015. During this period of time, 91 patients with S-ICD were matched to TV-ICD patients using single centre NCDR ICD Registry Data based on dialysis status, gender, and age. Intra- and post-operative complications and deaths were examined within the first 180 days following implantation. Patients with S-ICDs had higher creatinine (2.3 ± 2.5 vs. 1.1 ± 0.7, P < 0.001) and were more likely to be on chronic dialysis (20.9% vs. 5.5%, P < 0.001) than TV-ICD patients. Patients in the S-ICD group were more likely to have had prior device infections (14.3% vs. 3.3%, P = 0.021) as well as prior TIA/CVA (14.3% vs. 4.4%, P = 0.049) compared to patients in the TV-ICD group. Seven patients experienced 7 complications or death in TV-ICD group and 5 patients experienced 7 complications or death in SQ-ICD group, P = 0.774.ConclusionIn this retrospective matched single centre cohort study, there was no significant difference in implantation complications or death in patients receiving single chamber TV-ICDs compared to S-ICDs within 6 months following implantation. This occurred despite more severe preexisting illness in the S-ICD group. Further investigation is needed to determine outcomes after longer-term follow-up.PubDate: Tue, 04 Apr 2017 00:00:00 GMT

Authors:Walsh M; Turner C, Timothy K, et al.Abstract: AimsTimothy syndrome (TS) is an extremely rare multisystem disorder characterized by marked QT prolongation, syndactyly, seizures, behavioural abnormalities, immunodeficiency, and hypoglycaemia. The aim of this study was to categorize the phenotypes and examine the outcomes of patients with TS.Methods and resultsAll patients diagnosed with TS in the United Kingdom over a 24-year period were reviewed. Fifteen centres in the British Congenital Arrhythmia Group network were contacted to partake in the study. Six patients with TS were identified over a 24-year period (4 boys and 2 girls). Five out of the six patients were confirmed to have a CACNA1C mutation (p.Gly406Arg) and the other patient was diagnosed clinically. Early presentation with heart block, due to QT prolongation was frequently seen. Four are still alive, two of these have a pacemaker and two have undergone defibrillator implantation. Five out of six patients have had a documented cardiac arrest with three occurring under general anaesthesia. Two patients suffered a cardiac arrest while in hospital and resuscitation was unsuccessful, despite immediate access to a defibrillator. Surviving patients seem to have mild developmental delay and learning difficulties.ConclusionTimothy syndrome is a rare disorder with a high attrition rate if undiagnosed. Perioperative cardiac arrests are common and not always amenable to resuscitation. Longer-term survival is possible, however, patients invariably require pacemaker or defibrillator implantation.PubDate: Fri, 24 Mar 2017 00:00:00 GMT

Authors:Vojtovič P; Kučera F, Kubuš P, et al.Abstract: AimsRight bundle branch block is associated with right ventricular (RV) electromechanical dyssynchrony, which may contribute to acute haemodynamic impairment after repair of tetralogy of Fallot (ToF). We sought to evaluate the effects of RV resynchronization on haemodynamics and tissue oxygenation during the first 24 h after surgery.Methods and resultsArterial pressures, cardiac output, and tissue oxygenation were measured in 28 consecutive patients (median age 10.1 months) during baseline sinus rhythm with right bundle branch block and after RV resynchronization by atrial-triggered RV free wall pacing in complete fusion with spontaneous activation. Studied variables were compared in a crossover design in four 5-min intervals (baseline rhythm and stimulation, 2x each). Resynchronization reduced the QRS complex duration from median 110 to 70 ms (P < 0.001), increased significantly median arterial systolic, mean and pulse pressure, cardiac index, left ventricular maximum +dP/dT and decreased central venous pressure (P < 0.001 for all). Both cerebral and renal oxygenation improved (P < 0.001). Eleven of the 28 patients showed a clinically highly significant resynchronization effect defined as an increase in arterial pulse pressure of ≥ 10%. The q-RV interval (expressed as % of QRS duration) at the RV pacing site during baseline rhythm was the only predictor of resynchronization effect.ConclusionsRV resynchronization carried short-term improvement of haemodynamics in children early after surgery for ToF and might be a useful non-pharmacologic adjunct to the management of haemodynamically compromised patients. Resynchronization effect was maximized when pacing from area of the latest RV activation.PubDate: Thu, 23 Mar 2017 00:00:00 GMT

Authors:Chorin E; Taub R, Medina A, et al.Abstract: AimsType 3 long QT syndrome (LQT3) is caused by gain-of-function mutations in the cardiac sodium channel gene (SCN5A). Previous reports on the long-term use of sodium channel blockers in LQT3 are sparse. The objective of the current study was to evaluate the long-term safety and efficacy of flecainide therapy in patients with LQT3 who carry the D1790G SCN5A mutation.Methods and resultsThe study population comprised 30 D1790G carriers who were treated with flecainide and followed for 1–215 months (mean 145 ± 54 months, median 140 months). The mean baseline (off-drug) QTc was 522 ± 45 ms, and shortened to 469 ± 36 ms with flecainide therapy, a mean decrease of 53 ms [10.1%] (P < 0.01). A QTc longer than 500 ms was evident in 53% of carriers at baseline, and only in 13% on flecainide. All carriers while being compliant with flecainide therapy had no cardiac events during an average follow up of 83 ± 73 months. Twenty carriers stopped flecainide after an average follow up of 40 ± 42 months without symptoms. Six of them (30%) had cardiac events 1–11 months after stopping flecainide. Flecainide induced the appearance of Brugada pattern in six carriers (20%, 5 males), was stopped in three and was not associated with arrhythmia. Sinus-node dysfunction was evident in six carriers (20%) and was fully corrected by flecainide in three.ConclusionsThese data suggest that long-term flecainide therapy is relatively safe and effective among LQT3 patients who carry the D1790G SCN5A mutation.PubDate: Tue, 28 Feb 2017 00:00:00 GMT

Authors:Ruwald A; Gislason G, Vinther M, et al.Abstract: AimsWe aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a ‘real-life’ setting.Methods and resultsFrom the Danish Pacemaker and ICD Registry we identified all 1st-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007–12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol reached target dosages more frequently than patients on metoprolol, with 39% of patients on carvedilol and 26% of patients on metoprolol at the time of implantation (P < 0.001 for all time-points). Increase in proportion of patients reaching target daily doses was observed for both carvedilol and metoprolol after ICD implantation. Carvedilol treatment was a strong predictor for being on target dose of BB at time of implant, as was treatment with angiotensin-converting enzyme inhibitors and/or spironolactone, no history of myocardial infarction, younger age and less pronounced heart failure symptomsConclusionIn a real-life setting of primary prevention ICD patients, 39% and 26% of patients were titrated to optimal target dose of carvedilol or metoprolol prior to implantation. A higher proportion of patients on carvedilol reached target dose, as compared with metoprolol.PubDate: Mon, 20 Feb 2017 00:00:00 GMT

Authors:Purmah Y; Proietti M, Laroche C, et al.Abstract: AimThe impact of rate and rhythm control strategies on outcomes in patients with atrial fibrillation (AF) remains controversial. Our aims were: to report use of rate and rhythm control strategies in European patients from the EURObservational Research Program AF General Pilot Registry. Secondly, to evaluate outcomes according to assigned strategies. Methods and resultsUse of pure rate and rhythm control agents was described according to European regions. 1-year follow-up data were reported. Among rate control strategies, beta-blockers were the most commonly used drug. Proportions of patients assigned to rhythm control varied greatly between countries, and amiodarone was the most used rhythm control drug. Of the original 3119 patients, 1036 (33.2%) were assigned to rate control only and 355 (11.4%) to rhythm control only. Patients assigned to a rate control strategy were older (P < 0.0001) and more likely female (P = 0.0266). Patients assigned to a rate control strategy had higher rates for any thrombo-embolic event (P = 0.0245), cardiovascular death (P = 0.0437), and all-cause death (P < 0.0001). Kaplan–Meier analysis showed that rate control strategy was associated with a higher risk for all-cause death (P < 0.001). On Cox regression analysis, rate control strategy was independently associated with all-cause death (P = 0.0256). A propensity matched analysis only found a trend for the association between rate control and all-cause death (P = 0.0664).ConclusionIn a European AF patients’ cohort, a pure rate control strategy was associated with a higher risk for adverse events at 1-year follow-up, and partially adjusted analysis suggested that rate control independently increased the risk for all-cause death. A fully adjusted propensity score matched analysis found that this association was no longer statistically significant, suggesting an important role of comorbidities in determining the higher risk for all-cause death.PubDate: Sat, 04 Feb 2017 00:00:00 GMT

Authors:Moran D; De Regibus V, de Asmundis C, et al.Abstract: AimsPulmonary vein isolation (PVI) has been demonstrated more effective in young patients, in which the substrate for atrial fibrillation (AF) is probably more confined to pulmonary vein potentials. The present study sought to focus on the midterm outcomes in patients under 40 years having undergone PVI with the Cryoballoon Advance because of drug resistant AF.Methods and resultsBetween June 2012 and December 2015, 57 patients having undergone Cryoballoon ablation (CB-A) below 40 years of age for AF in our centre were retrospectively analysed and considered for our analysis. All patients underwent this procedure with the 28 mm Cryoballon Advance. All 227 veins were successfully isolated without the need for additional focal tip ablation. Median follow-up was 18 ±10 months. The freedom from AF after a blanking period of 3 months was 88% in our cohort of patients younger than 40 years old. The most frequent periprocedural complication was related to the groin puncture and occurred in 2 patients. After a single procedure, the only univariate predictor of clinical recurrence was the diagnosis of hypertrophic cardiomyopathy.ConclusionYoung patients affected by AF can be effectively and safely treated with CB-A that grants freedom from AF in 88% of the patients at 18 months follow-up following a 3-month blanking period. All veins could be isolated with the large 28 mm Cryoballoon Advance only.PubDate: Wed, 25 Jan 2017 00:00:00 GMT

Authors:Koyak Z; de Groot J, Krimly A, et al.Abstract: AimsIn adults with congenital heart disease (CHD) heart failure is one of the leading causes of morbidity and mortality but experience with and reported outcome of cardiac resynchronization therapy (CRT) is limited. We investigated the efficacy of CRT in adults with CHD.Methods and resultsThis was a retrospective study including 48 adults with CHD who received CRT since 2003 in four tertiary referral centres. Responders were defined as patients who showed improvement in NYHA functional class and/or systemic ventricular ejection fraction by at least one category. Ventricular function was assessed by echocardiography and graded on a four point ordinal scale. Median age at CRT was 47 years (range 18–74 years) and 77% was male. Cardiac diagnosis included tetralogy of Fallot in 29%, (congenitally corrected) transposition of great arteries in 23%, septal defects in 25%, left sided lesions in 21%, and Marfan syndrome in 2% of the patients. The median follow-up duration after CRT was 2.6 years (range 0.1–8.8). Overall, 37 out of 48 patients (77%) responded to CRT either by improvement of NYHA functional class and/or systemic ventricular function. There were 11 non-responders to CRT. Of these, three patients died and four underwent heart transplantation.ConclusionIn this cohort of older CHD patients, CRT was accomplished with a success rate comparable to those with acquired heart disease despite the complex anatomy and technical challenges frequently encountered in this population. Further studies are needed to establish appropriate guidelines for patient selection and long term outcome.PubDate: Fri, 20 Jan 2017 00:00:00 GMT

Authors:Iwasawa J; Miyazaki S, Takagi T, et al.Abstract: AimsSubclinical brain damage due to microembolization could occur during catheter ablation procedures. We evaluated the microembolic signals (MESs) detected by transcranial Doppler during ablation of supraventricular tachycardias (SVTs) or idiopathic ventricular arrhythmias (VAs) with the use of different approaches.Methods and resultsThis study included 36 patients (23 men, 49 ± 21 years) who underwent catheter ablation of SVTs (n = 27) or idiopathic VAs (n = 9). Left-sided ablation was performed by either a transaortic (Group 1, n = 11) or transseptal approach (Group 2, n = 9). A sole right-sided ablation was performed in the remaining 16 patients (Group 3). The MESs were counted throughout the procedure, and then analysed offline with a frequency analysis. The mean number of radiofrequency applications, total energy delivery time, total application energy, and total procedure time were 5.8 ± 5.0, 4.3 ± 3.3 min, 6625 ± 4633 J, and 81 ± 40 min, respectively, and there was no significant difference in the parameters between the three groups. The mean total number of MESs was 3.8 ± 3.1 in Group 1, 75 ± 58 in Group 2, and 0.3 ± 0.6 in Group 3 (P = 0.001). Few MESs were detectable during the radiofrequency energy deliveries in all groups. In Group 2, 19 ± 18 MESs were detected during the transseptal puncture period, and subsequently a relatively even distribution of emboli formation was observed. A frequency analysis suggested that 99, 91, and 100% of MESs were gaseous, in Group 1, Group 2, and Group 3, respectively. No neurological impairment was observed in any patients after the procedure.ConclusionThe retrograde aortic approach might potentially have a lower risk of subclinical brain damage than the transseptal approach during left-sided catheter ablation.PubDate: Fri, 20 Jan 2017 00:00:00 GMT

Authors:De Ponti R; Marazzi R, Doni L, et al.Abstract: AimsDuring pulmonary vein isolation (PVI), even if operators are aware of the contact force (CF), its values may greatly vary and the impact of cardiac rhythm has not been thoroughly investigated yet. This study aims at assessing the actual values of CF, the applications with suboptimal CF, and the impact of cardiac rhythm on CF during PVI.Methods and resultsTwenty patients undergoing point-by-point PVI with a CF-sensing catheter were considered. CF target was between 6 and 40 g. The mean CF per application (mCF) was evaluated and considered suboptimal if ≤5 g. The real-time graphic of CF was also evaluated and classified as pulsatile if regular variations synchronous with the atrial rate were seen; otherwise it was irregular. To achieve PVI, 1458 applications were delivered; 287 (19.68%) had suboptimal mCF. A great variability of mCF was seen according to anatomy, operators and patients. Compared to applications in atrial fibrillation (AF), those in sinus rhythm (SR) showed a higher median value of mCF (11 vs. 9 g; P = 0.0099) and a lower percentage of suboptimal mCF (17.95% vs. 25.15%; P = 0.0051). Compared to the irregular, the pulsatile pattern, almost exclusively observed in SR, was associated with higher mCF (14.69 ± 8.77 vs. 10.79 ± 7.89 g; P < 0.0001) and fewer suboptimal applications (8.02% vs. 27.73%; P < 0.0001).ConclusionDuring PVI, several factors influence CF, which, despite optimization attempts, can be suboptimal in ∼20% of the applications. However, CF is higher in SR than in AF and this is strictly associated with a pulsatile pattern of instant CF values.PubDate: Mon, 09 Jan 2017 00:00:00 GMT

Authors:Souissi Z; Boulé S, Hermida J, et al.Abstract: AimsStudies assessing radiofrequency ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) report VT recurrences, but have not evaluated the impact of RFA on relevant clinical events during follow-up. We aimed to investigate relevant RFA outcomes in a multicentric registry.Methods and resultsThis study included 49 patients with ARVC (46 with definite diagnosis, 3 with borderline diagnosis according to revised Task Force Criteria) who underwent 92 RFA procedures (83 endocardial, 9 combined endo–epicardial) between 1999–2015. Ventricular tachycardia recurrences and VT burden were assessed after each procedure or after the last RFA. Over a mean follow-up of 64 ± 51 months, VT-free survival was 37% at 1 year, 19% at 5 years, and 14% at 10 years. Ventricular tachycardia burden was significantly reduced after one procedure (23 vs. 11 VT episodes/year, P < 0.01) and after the last RFA (14 vs. 2 VT episodes/year, P < 0.01). Over a mean follow-up of 49 ± 52 months, clinical response after the last RFA (freedom from sudden cardiac death, VT requiring hospitalization, or heart transplantation) was 86% at 1 year, 69% at 5 years, and 60% at 10 years. Clinical response was associated with right ventricular dysfunction (RVD) and low numbers of mappable VT before the first RFA.ConclusionRFA was predominantly targeted at the endocardial surface. Ventricular tachycardia recurrences were common, but few ARVC patients experienced major clinical events during follow-up. Further studies should investigate the benefit of extensive substrate ablation combined with endo–epicardial strategies.PubDate: Sat, 24 Dec 2016 00:00:00 GMT

Authors:Knecht S; Pradella M, Reichlin T, et al.Abstract: AimsAtrial fibrillation (AF) is associated with changes in left atrial (LA) volume, but the relationship between LA size, AF burden, and electrical conduction behaviour is still uncertain. The aim of this study was to quantify the association and impact of these parameters on the single-procedure outcome after circumferential antral ablation for pulmonary vein isolation.Methods and resultsLeft atrial assessment was performed in 129 consecutive patients using pre-procedural imaging in three dimensions (sphericity, indexed volume), two dimensions (diameters), and from echocardiography in one dimension (long axis). Atrial fibrillation burden was classified based on the clinical assessment as paroxysmal and persistent and based on a validated scoring system including frequency, duration of AF episodes, and number of cardioversions into four grades (minimal, mild, moderate, and severe). P-wave duration and PR interval was measured on the 12-lead electrocardiogram at the end of the procedure. Atrial fibrillation burden score (AFB) was minimal (2%), mild (75%), moderate (9%), and severe (14%) and 65% had paroxysmal and 35% had persistent AF. The recurrence rate was significantly higher in patients with persistent AF, with higher AFB, with prolonged P-wave, and with an indexed LA volume > 55 mL/m2. In multivariable analysis, AFB (hazard ratio: 2.018(1.383–2.945), P > 0.001) and a prolonged P-wave (hazard ratio: 2.612(1.248–5.466), P = 0.011) were identified as significant predictors for AF recurrenceConclusionsIn our cohort of patients with symptomatic AF, the AFB and the P-wave duration but none of the anatomical parameter revealed to be independent predictors for AF/AT recurrence after circumferential antral pulmonary vein isolation.PubDate: Thu, 22 Dec 2016 00:00:00 GMT

Authors:Killu A; Sugrue A, Munger T, et al.Abstract: AimsPatient movement while under moderate/deep sedation may complicate percutaneous epicardial access (EpiAcc), mapping and ablation. We sought to compare procedural outcomes in patients undergoing EpiAcc under sedation vs. general anaesthesia (GA) for ablation.Methods and resultsPatients undergoing EpiAcc between January 2004 and July 2014 were included. Safety, procedural, and clinical outcomes were compared between patients undergoing EpiAcc under sedation or GA for ventricular tachycardia or premature ventricular complex ablation. Between January 2004 and July 2014, 170 patients underwent EpiAcc (mean age, 53.2 ± 15.8 years; average ejection fraction, 44.3 ± 15.3%). The majority (122 [72%] patients) were male. GA was used in 69 (40.6%). There was no difference in route of access (more often anterior, 53.0%) or the rate of successful access (96% overall) between groups. Similarly, the site of ablation (endocardial vs. epicardial vs. combined endocardial/epicardial) was similar between groups. Complications were equally seen between groups—the most frequent event/complication was pericardial effusion, occurring in 10.6% of patients. Finally, procedural and clinical success rates between GA and sedation groups were comparable (93 vs. 91% and 44 vs. 51%, respectively, P > 0.05).ConclusionsChoice of anaesthesia for EpiAcc does not appear to significantly affect safety and procedural or clinical outcomes. For patients in whom anaesthesia may pose increased risk, it is reasonable to obtain epicardial access under sedation.PubDate: Tue, 15 Nov 2016 00:00:00 GMT